Factors influencing postnatal emotional distress and barriers to help seeking

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Abstract

Introduction: Historically, postnatal depression (PND) has been the main focus for
maternal mental health. However, there is evidence that women experience other
emotional difficulties in this period. Mental health is particularly important in the
postnatal period as maternal morbidity has far reaching consequences for mother,
child and partner. Despite effective treatments being available a large number of
women do not seek help for postnatal mental health problems. This study aims to
explore emotional distress in the postnatal period and examine factors influencing
postnatal emotional distress, in order to facilitate detection and prevention. It aims to
gain a better understanding of what the perceived barriers to seeking help in the
postnatal period may be, and explore what interventions may be acceptable to women
at this time in their lives.
Method: A review of the literature failed to find a measure suitable to assess barriers
to help-seeking. A questionnaire was developed based on qualitative literature,
interviews with postnatal women and expert opinion. This questionnaire was piloted
in a pack of questionnaires including: a measure of distress (DASS-21), social support
(SOS) and life events (adapted form of the LTE). The study used a cross-sectional
survey design to investigate the symptomatology of depression, anxiety and stress in a
group of postnatal women in West Lothian. A between subjects design was adopted
to look at differences between women with and without significant levels of
symptomatology.
Results: The responses to questionnaires were entered into SPSS. 16.7 per cent of
the sample was identified as suffering from depressive symptomatology, 9.1per cent
anxiety and 18.2 per cent stress symptomatology (as identified by the DASS-21).
Multiple regression revealed that stressful life events and lack of social support were
predictive of postnatal emotional distress. In addition parity was predictive of
depressive symptomatology. Barriers to help-seeking were influenced by social
support and level of distress, suggesting that vulnerable women may be less likely to
seek help. In addition information was gathered about women’s preferences for
support with postnatal emotional distress.
Discussion: Evidence was presented for widening the focus of PND to look at
postnatal emotional distress. Risk factors predictive of distress were highlighted and
interventions suggested based on these and women’s treatment preferences. Barriers
to help-seeking appear to be more salient for vulnerable women, who are most in need
of support. The implications of this research are relevant for policy makers and
further research in aspects of perinatal and postnatal mental health.